幽门螺杆菌与食管癌的因果关联:基于孟德尔随机化研究
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青海大学附属医院

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青海省科技厅项目(2021-ZJ-963Q);国家自然科学基金项目(82160131)


The Causal Association Between Helicobacter pylori and Esophageal Cancer: A Mendelian Randomization Study
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Qinghai Provincial Department of Science and Technology Project (2021-ZJ-963Q); National Natural Science Foundation of China (82160131)

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    摘要:

    目的:本研究旨在探索幽门螺杆菌(Helicobacter pylori,HP)与食管癌(Esophagealcancer,EC)之间的潜在因果关系,采用了传统的两样本孟德尔随机化(Mendelian Randomization,MR)方法结合贝叶斯加权孟德尔随机化以及连锁不平衡分数回归(LD Score Regression,LDSC),并对存在争议的结果进行了综合Meta分析,以增强研究的证据基础。方法:本研究分析了全基因组关联研究(genome-wide association stud,GWAS)数据,以HP感染作为暴露因素,EC作为结局变量。采用了多种孟德尔随机化方法,包括逆方差加权分析法、加权中位数法、MR Egger法、Simple mode法以及Weighted mode法来探索HP与EC之间的关联性。此外,还引入了贝叶斯加权孟德尔随机化方法,并通过假设发现率(false discovery rate, FDR)进行结果矫正,以提高分析的精确性。研究还包括了离群值检测、异质性检测、敏感性分析、多效性分析,并且移除了可能因混杂因素影响结果的单核苷酸多态性(single nucleotide polymorphisms,SNPs)。对于争议较大的结果,进行了Meta分析以提供更广泛的视角。同时,通过Steiger测试和反向孟德尔随机化方法排除了潜在的反向因果关系。此外,本研究还利用LDSC评估了HP与EC之间的遗传相关性。结果:经过综合分析,无论是传统的两样本MR还是贝叶斯加权MR在FDR矫正后,结果均表明HP与EC之间没有统计学上的因果联系(P>0.05)。所有分析结果均未显示出多效性存在(P>0.05),且“留一法”检验也证实了所得结果的稳健性。然而,对抗幽门螺杆菌IgG血清阳性和幽门螺杆菌GroEL抗体水平的遗传相关性分析提示,这些标志物与食管腺癌之间可能存在潜在的遗传相关性(P<0.05)。结论:尽管采用了遗传相关的统计方法,本研究发现当前的证据不足以支持HP与EC之间存在明确的因果关系。这一发现强调了需要更大规模的GWAS数据和更细致的亚型特异性分析来进一步探究这两种病状之间关系的必要性。未来的研究应包括更广泛的人群和地理区域,以增强发现的一般性和适用性,同时应探讨HP不同菌株的具体影响以及可能的生物机制,为EC的预防和治疗提供更有力的科学依据。

    Abstract:

    Objective: This study aimed to explore the potential causal relationship between Helicobacter pylori (HP) infection and esophageal cancer (EC). We employed traditional two-sample Mendelian randomization (MR) methods, combined with Bayesian-weighted MR and linkage disequilibrium score regression (LDSC), and conducted a comprehensive meta-analysis on controversial findings to strengthen the evidence base. Methods: The analysis incorporated genome-wide association study (GWAS) data with HP infection as the exposure and EC as the outcome. We utilized a variety of MR methods, including inverse-variance weighted analysis, weighted median, MR-Egger, Simple mode, and Weighted mode to investigate the association between HP and EC. Additionally, Bayesian-weighted MR was introduced and results were corrected using the false discovery rate (FDR) to enhance precision. The study also involved outlier detection, heterogeneity testing, sensitivity analysis, pleiotropy assessment, and the removal of single nucleotide polymorphisms (SNPs) potentially affected by confounding factors. For results that were particularly contentious, a meta-analysis was performed to provide a broader perspective. Potential reverse causation was assessed using Steiger testing and reverse MR. Furthermore, LDSC was utilized to evaluate the genetic correlation between HP and EC. Results: The comprehensive analyses showed that both traditional two-sample MR and Bayesian-weighted MR after FDR correction indicated no statistically significant causal relationship between HP and EC(P>0.05). No pleiotropy was evident(P>0.05), and the robustness of the results was confirmed by the leave-one-out test. However, genetic correlation analyses of anti-Helicobacter pylori IgG serum positivity and Helicobacter pylori GroEL antibody levels suggested a potential genetic link with esophageal adenocarcinoma(P<0.05). Conclusion: Despite the use of advanced statistical methodologies, the current evidence is insufficient to support a definitive causal relationship between HP and EC. This finding underscores the need for larger-scale GWAS data and more detailed subtype-specific analyses to further explore the relationship between these two conditions. Future research should include a broader range of populations and geographical areas to enhance the generalizability and applicability of findings, while also investigating the specific impacts of different HP strains and possible biological mechanisms, providing stronger scientific support for the prevention and treatment of esophageal cancer.

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  • 收稿日期:2024-08-28
  • 最后修改日期:2024-12-24
  • 录用日期:2025-09-12
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